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Correspondence |

“Cutaneous T-Cell Lymphoma”: Cutaneous TNMania in Cutaneous Lymphomas—Reply

Werner Kempf, MD
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Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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Arch Dermatol. 2009;145(7):843-843. doi:10.1001/archdermatol.2009.136
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According to the World Health Organization (WHO)–European Organization for Research and Treatment of Cancer (EORTC) classification system for cutaneous lymphomas and the WHO classification system for tumors of hematopoietic and lymphoid tissues, GSS is included as a variant or subtype of mycosis fungoides.1 2 We agree that the use of TNM may be difficult for unusual and rare variants of mycosis fungoides; however, neither the initial TNM classification in its classic scheme nor the staging system recently proposed by the International Society for Cutaneous Lymphomas–EORTC restricts its use to the classic mycosis fungoides or explicitly excludes mycosis fungoides variants.3 4

All patients with GSS in our series5 presented with infiltrated plaques involving less than 10% of the body surface, as indicated in detail in Table 1 of our article. In addition, patches were found in 3 of 4 patients. However, we never claimed that the histologic pattern illustrated in our Figure 10 correlated to a patch lesion. Clinically, it correlated with a plaque lesion. The term tumor is not defined histologically by the presence of a diffuse infiltrate of small lymphocytes within all dermal layers. It is defined by the clinical manifestation of the disease with nodular lesions, which were not present in any of the patients with GSS.

In Table 1 of our study,5 the disease presentation and extent at diagnosis are summarized by both the description of the lesion type and the TNM stage. Thus our data fulfill entirely the criteria of appropriate and precise dermatologic and oncologic terminology. It is true that precision and perfection in dermatologic language should be the goal of dermatologic literature; however, particularly in the field of cutaneous lymphomas, our literature is read by nondermatologists too, and avoiding the use of TNM classification would neither add precision to the language nor result in better communication among different fields of medicine. Nor would it lead to better disease management. By avoiding any shortcuts or alleged separations, our data facilitate a precise communication with dermatologists and oncologists.

AUTHOR INFORMATION

Correspondence: Dr Kempf, Department of Dermatology, University Hospital Zürich, Gloriastrasse 31, CH-8091 Zürich, Switzerland (werner.kempf@access.uzh.ch).

REFERENCES

Willemze  R, Jaffe  ES, Burg  G.  et al.  WHO-EORTC classification for cutaneous lymphomas. Blood 2005;105 (10) 3768- 3785
PubMed
Ralfkiaer  E, Cerroni  L, Sander  CA.  et al.  Mycosis fungoides.  In: Swerdlow  SHCamp  EHarris  NL eds, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: International Agency for Research on Cancer; 2008;: 296-- 298
International Union Against Cancer,  TNM Classification of Malignant Tumors. 6th ed. New York, NY: Wiley-Liss; 2002;
Olsen  E, Vonderheid  E, Pimpinelli  N.  et al. ISCL/EORTC,  Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization for Research and Treatment of Cancer (EORTC). Blood 2007;110 (6) 1713- 1722
PubMed
Kempf  W, Ostheeren-Michaelis  S, Paulli  M.  et al. Cutaneous Lymphoma Histopathology Task Force Group of the European Organization for Research and Treatment of Cancer,  Granulomatous mycosis fungoides and granulomatous slack skin: a multicenter study of the Cutaneous Lymphoma Histopathology Task Force Group of the European Organization for Research and Treatment of Cancer (EORTC). Arch Dermatol 2008;144 (12) 1609- 1617
PubMed

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Willemze  R, Jaffe  ES, Burg  G.  et al.  WHO-EORTC classification for cutaneous lymphomas. Blood 2005;105 (10) 3768- 3785
PubMed
Ralfkiaer  E, Cerroni  L, Sander  CA.  et al.  Mycosis fungoides.  In: Swerdlow  SHCamp  EHarris  NL eds, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: International Agency for Research on Cancer; 2008;: 296-- 298
International Union Against Cancer,  TNM Classification of Malignant Tumors. 6th ed. New York, NY: Wiley-Liss; 2002;
Olsen  E, Vonderheid  E, Pimpinelli  N.  et al. ISCL/EORTC,  Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization for Research and Treatment of Cancer (EORTC). Blood 2007;110 (6) 1713- 1722
PubMed
Kempf  W, Ostheeren-Michaelis  S, Paulli  M.  et al. Cutaneous Lymphoma Histopathology Task Force Group of the European Organization for Research and Treatment of Cancer,  Granulomatous mycosis fungoides and granulomatous slack skin: a multicenter study of the Cutaneous Lymphoma Histopathology Task Force Group of the European Organization for Research and Treatment of Cancer (EORTC). Arch Dermatol 2008;144 (12) 1609- 1617
PubMed

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